Serum Uric Acid As an Independent Risk Factor on Progression of Chronic Kidney Disease in Gout Patients with Uric Acid Lowering Agent

Young Hyup Lim¹, Eun-Jung Park¹, Seulkee Lee², Hemin Jeong³, Hyungjin Kim⁴, Jinseok Kim¹, Jaejoon Lee⁵, Hoon-Suk Cha³ and Eun-Mi Koh⁶, ¹Internal Medicine, Department of Medicine, Jeju National University Hospital, Jeju University School of Medicine, Republic of Korea, Jeju, South Korea, ²Internal Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, Seoul, South Korea, ³Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, ⁴Internal Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea, Seul, South Korea, ⁵Division of Rheumatology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, ⁶Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Gout and uric acid

Session Information

Session Title: Metabolic and Crystal Arthropathies: Mechanisms of Disease

Session Type: Abstract Submissions (ACR)

Background/Purpose

Hyperuricemia is particularly common in patients with chronic kidney disease (CKD). Its role, however, as a risk factor for renal outcomes of CKD is debated. This aim of study was to evaluate long-term effect of serum uric acid (SUA) level on progression of CKD in gout patients with uric acid lowering treatment.

Methods

All patients who had a first visit for gout with CKD at Samsung Medical Center between 1995 and 2003, and follow-up until December 2012 or expired during follow-up period were included and retrospective analyzed. CKD was defined as an estimated glomerular filtration rate (GFR) of < 60 mL/min/1.73m² via MDRD Study equation more than 3 months. All serum creatinine and matched SUA taken during follow-up period were analyzed by using Mixed effect model to determine the effect of SUA level on renal outcome.

Results

One-hundred eleven gout patients with CKD were observed. The mean age of the patients at diagnosis of gout was 51.3 and mean follow-up duration was 13 years. Baseline eGFR and serum creatinine were 47.7 mL/min/1.73m² and 1.62 mg/dL, respectively. Maintaining the SUA below 6 mg/dL showed protective effect on serum creatinine and eGFR compared with SUA more than 6 mg/dL (p < 0.0001 and p = 0.02, respectively). Mixed effect model demonstrated that the protective effect on renal outcome with maintaining the SUA below 6 mg/dL was statistically significant after adjusting baseline age, follow-up time, hypertension, diabetes mellitus, history of cardiovascular disease, obesity, and intrinsic renal disease (p < 0.0001). Hypertension, diabetes mellitus and follow-up time were independently associated with progression of chronic kidney disease (p < 0.001, p < 0.001 and p < 0.001, respectively). In particular, for every 1 mg/dL increase of the SUA, serum creatinine revealed to be increased 0.02 mg/dL when the SUA is more than 6 mg/dL (p < 0.0001).

Conclusion

Our long term follow-up data demonstrated the SUA level was associated with progression of CKD in gout patients. Maintaining of SUA level below 6 mg/dL would be essential to protect renal function in gout patients with CKD.

Disclosure:

Y. H. Lim,
None;

E. J. Park,
None;

S. Lee,
None;

H. Jeong,
None;

H. Kim,
None;

J. Kim,
None;

J. Lee,
None;

H. S. Cha,
None;

E. M. Koh,
None.

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